New rules limiting work schedules for medical residents don’t go far enough in protecting patients from errors caused by exhausted trainees, says an article signed by 26 leading medical and health experts, that is being published today.
The rules, approved by the Accreditation Council for Graduate Medical Education and scheduled to take effect on July 1, limit the shifts of first-year residents to no more than 16 hours without sleep. The accrediting group allowed some exceptions for more-senior residents, including those in surgical programs. Those trainees can work up to 28 consecutive hours under the new rules.
Residents—medical-school graduates who work under a senior physician’s supervision—can now generally work up to 24 hours without sleep.
Lucian Leape, an adjunct professor of health policy at the Harvard School of Public Health and a co-author of the report, calls the current system “an abuse of patient trust.”
“Few people enter a hospital expecting that their care and safety are in the hands of someone who has been working a double shift or more with no sleep,” he said in a written statement. “If they knew, and had a choice, the overwhelming majority would demand another doctor or leave.”
The article noted that a report last year from the Inspector General’s Office of the U.S. Department of Health and Human Services estimated that 180,000 Medicare patients die each year because of harm resulting from medical care.
A 2008 report by the Institute of Medicine concluded that such errors are often caused by fatigued residents, and called on residency-training programs to eliminate shifts of more than 16 hours at a stretch for all residents.
But some medical educators counter that cutting work hours could actually endanger patients more because shorter schedules would deprive residents of crucial training time. They also worry that more-frequent shift changes could result in errors as one resident hands off patients to another.
Among the key recommendations of the report released today:
- Capping all resident-physician work shifts at 12 to 16 hours.
- Making work-hour compliance a condition for residency programs to receive Medicare support.
- Identifying “in real time” when a resident is overworked and additional staff needs to be called in.
The report released today came out of a conference held last summer at Harvard Medical School.
The article, “Implementing the 2009 Institute of Medicine Recommendations on Resident Physician Work Hours, Supervision, and Safety: Report from a Conference at Harvard Medical School,” is available in the June 24 issue of the online journal Nature and Science of Sleep.
